Active NPI
Micah Chan, D.M.D., M.S.
- Periodontics
- Richfield, MN
National Provider Identifier
1083083323
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- S99
- Practice address
- 6601 Lyndale Ave S
Richfield, MN 55423-2477 - Phone
- (612) 243-9357
- NPI assigned
- Sep 16, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | S99 | MN | Primary |
Addresses
Primary practice location
6601 Lyndale Ave S
Richfield, MN 55423-2477
Mailing address
8301 Stanley Rd
Apt #114
Bloomington, MN 55437-1282
Phone (612) 910-6203
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160113003088 | MN | Order and Referring Only - Dentist | 5698077279 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S99 | MN | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442361600000",
"number": "1083083323",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8301 STANLEY RD",
"address_2": "APT #114",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554371282",
"telephone_number": "612-910-6203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6601 LYNDALE AVE S",
"city": "RICHFIELD",
"state": "MN",
"postal_code": "554232477",
"telephone_number": "612-243-9357"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAN",
"first_name": "MICAH",
"name_prefix": "Dr.",
"credential": "D.M.D., M.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-09-16",
"last_updated": "2015-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MN",
"license": "S99",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richfield, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.